Ocular Toxoplasmosis Reactivation Following Intraocular Interventions: A Scoping Review

Ocular toxoplasmosis (OT) remains a significant global health concern as the leading cause of infectious posterior uveitis, frequently resulting in permanent visual impairment due to its high and unpredictable recurrence rates. While various risk factors for reactivation are well-established, the specific role of intraocular interventions—ranging from phacoemulsification and pars plana vitrectomy to intravitreal injections of anti-VEGF or corticosteroids—as potential triggers for disease recurrence is not yet fully understood. Currently, the ophthalmic community lacks standardized evidence-based guidelines regarding the perioperative management of these patients, leading to significant variability in clinical practice, particularly concerning the use and timing of prophylactic antitoxoplasmic therapy. This clinical uncertainty is further complicated by the phenomenon of subclinical or peripheral retinochoroidal scars that may go undetected during routine pre-operative fundoscopic assessments, only to reactivate following the inflammatory stimulus or mechanical trauma associated with a procedure. The primary purpose of this research project is to conduct a scoping review, following the rigorous methodology established by the Joanna Briggs Institute (JBI), to systematically map and characterize the available evidence surrounding OT reactivation in the context of intraocular interventions. This review defines reactivation as the development of active lesions regardless of whether the underlying scar was known prior to the intervention or identified postoperatively. By synthesizing data from both retrospective studies and a predominant body of case reports, this project seeks to define the typical clinical presentation and temporal onset of post-procedural reactivation. A key objective of this work is to explore the differences in outcomes and reporting between patients with a known history of OT and those identified as having silent scars only after a postoperative event occurs. The expected outcomes of this scoping review include a comprehensive categorization of the types of procedures most frequently associated with reactivation and a detailed analysis of both patient-related and procedure-related factors described as potential triggers. Furthermore, the review will provide a summary of the various prophylactic and therapeutic regimens currently reported in the literature, revealing the degree of heterogeneity in global practices. By identifying the limitations within the existing evidence base, this project will highlight critical knowledge gaps that prevent the formation of a clinical consensus. Ultimately, this work aims to provide a foundational evidence map that can inform better pre-operative screening protocols, guide perioperative therapeutic decisions, and establish the necessary parameters for future prospective research into the prevention of ocular toxoplasmosis reactivation.